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Saturday, 25 August 2012

#24 Nipple stimulation in childbirth - does it work?

FACT OF THE DAY: Nipple stimulation has been used around the world for centuries to bring on labour

I don’t think I can be the only one who was incredulous the first time I heard that nipple stimulation can be a good way of getting labour going.

There was a definite snigger around the room at the antenatal class as we sat there absorbing this ‘titillating’ piece of information. We had been hoping to hear about medical advances and scientific methods that would help us in childbirth, not something as simple, available and sexual as nipple stimulation.

After my initial surprise I was quite quick to discard this piece of advice, imagining that it would be unlikely to be effective, and that it probably wouldn't be what I felt like doing in the early stages of labour.

However, since embarking on my research I find that I may have been wrong to dismiss this idea so quickly. A number of cultures around the world have independently come up with this strategy.

For example the Lepcha, a rice-farming group that live in the Himalayas, and the Siriono, hunter-gathers from the Amazonian rain forest, although from different continents and totally different ways of life, have in common a relaxed attitude towards sex and a lack of inhibition about their bodies, and both cultures use nipple stimulation to speed labour. The Siriono also seem to realise that orgasms stimulate the uterus to contract, and women with intermittent labour may have sex to try to encourage their labour to start in earnest.

Unknown to the cultures involved, nipple stimulation causes a reaction in the brain and a release of a hormone called oxytocin which is responsible for causing the cervix to dilate. Often artificial oxytocin is given intravenously to speed up contractions in labour wards across the Western world, but nipple stimulation is also now suggested as a less intrusive option to induce labour or get a slow labour going.

Like being upright during childbirth, this may be another area where we can learn from current non-Western practises. And just like being upright in childbirth, it also was practised in Europe before male doctors took over the process of managing childbirth from female midwives - there are historical references to nipple stimulation in labour going back to the 18th and 19th centuries in Europe.

So, does nipple stimulation actually work?

There is enough anecdotal evidence to suggest that it certainly works for some women. You only have to Google ‘nipple stimulation’ and you’ll find many accounts by women who are very happy to share their nipple stimulation success stories.The fact that many different cultures around the world have come up with this also suggests that it must be effective sometimes.

However, reading through the studies and journals about whether nipple stimulation really is an effective method of speeding delivery, the results are unsatisfyingly inconclusive. Studies have looked at various techniques, such as using a breast pump (the idea being to simulate an infant suckling), or even a husband/partner (not sure what the idea is)!

This?

Or this?

One of the problems in testing this method seems to be finding sufficient numbers of willing volunteers to take part in such a study (many women who say they will be happy to try nipple stimulation understandably change their minds when the moment comes and events unfold in a different way to how they had imagined). Another problem is agreeing what counts as nipple stimulation, is it 5 minutes stimulation every 15 minutes, or 1 minute every 5 minutes? And a further problem is making sure that all women were at the same point of cervical ripeness at the start of the procedure. All in all, it is understandably a challenging area to test.

In the many studies undertaken, some found nipple stimulation to be as effective as artificial intravenous oxytocin in establishing labour, others didn’t…

I wonder if in non-Western societies where there is no artificial intravenous alternative, where without gadgets women are more used to using touch and sensation in their experience pregnancy and childbirth, and where a slow and difficult labour could very well be life-threatening, the effectiveness of nipple stimulation might be more obvious.

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If you would like to find out more, take a look at

Ed Richardson, SA and Guttmacher, A (1967) Childbearing – its social and psychological aspects The Williams and Wilkins Company